TRAINING OPPORTUNITIES: STOP THE BLEED MONTH

[Gallo Pazzesco]

The hands on training consisted of the use and application of a tourniquet, we used CAT training models along with cheaper knockoffs. The instructor strongly emphasized the purchase of CAT, SOF-T's through authorized dealers and/or the manufacturers directly if we chose to add a tourniquet to our bleed control kit. Purchasing knock-offs from Ebay, Amazon, etc. was a serious No-No. We also performed wound packing using Z-Fold and rolled gauze. All of us were surprised by how much gauze it could take to completely fill a large wound cavity before direct pressure could be applied with our fingers and hands. "Keep stuffing it in there." was the all too common reply from the instructor when asked if we used enough gauze!.

Okay, well, (cringe) Tampon just came out with a new line of Va Jay Jay plugs ranging from extra small to extra large. Xsm is what we want for a trauma kit to deal with 30 cal and smaller entry holes. Exit holes are another story where a sack of gauze would apply no doubt.

Would be interested to know what they said about clotting agents.

Thanks all.

[GTF425]

Please do not use tampons for GSWs. The small amount of cotton in a tampon absorbs roughly 5-10mL of fluid and you are not compressing the vessels that are actively bleeding to begin to allow the clotting cascade to work. Without going deep in to the A&P, you need to apply direct, focal pressure on the source of the bleed and let your body form a clot at the point of injury. While the physical entry wound itself may be "pluggable", the actual source of the bleeding (specifically if a large vessel is damaged) will be within the wound itself.

There are different types of dressings impregnated with hemostatic agents. ChitoGauze and Combat Gauze are in common use and both are very effective with slightly different mechanisms to them both.

ChitoGauze (and Celox) have chitosan that basically forms a clot on the dressing itself and works separately of the Pt's clotting factors. Combat Gauze has kaolin in it, which supplements someone's intrinsic clotting capabilities (specifically, Factor XII) and helps expedite the formation of a clot. Both require direct, focal pressure on the injured vessel itself and can not just be stuffed in a wound and expected to work.

Fortunately, unless a major vessel is struck, most GSWs look like a pencil hole with a little swelling around them. I've had a handful of dramatic "holy shit" wounds and a lot of fairly unremarkable ones, so there's no real standard. Planning a catch all of "entry" vs "exit" with regards to wound management is a poor plan, as I have no idea what my next GSW will look like but will treat accordingly. If a wound is not actively bleeding, it may not require anything more than a dressing, and not every wound will require it to be packed. Treat accordingly.

Simply absorbing fluid does nothing to support the clotting cascade. I've personally S-packed three rolls of kerlex in an inguinal GSW and spent the entire transport with two fingers buried in the wound applying pressure while they screamed and bucked, and my hand was so sore I thought I had broken my fingers when I transferred them at the ER. I don't have commercial junctional TQs and can't REBOA, so that was the only option. Pack the hell out of it and get to a surgeon as quickly as possible.

Some supplemental reading RE: tampons. This man knows what he speaks of-

From Andrew Fisher (former 75th PA; instrumental in the ROLO program)-
https://havokjournal.com/fitness/med...ng-hemorrhage/

[WickedWillis]

Okay, well, (cringe) Tampon just came out with a new line of Va Jay Jay plugs ranging from extra small to extra large. Xsm is what we want for a trauma kit to deal with 30 cal and smaller entry holes. Exit holes are another story where a sack of gauze would apply no doubt.

Would be interested to know what they said about clotting agents.

Thanks all.

Tampons are bad advice friend.

[Gallo Pazzesco]

Thanks GTF. I'll let the guys at the range know. Will just show them this response actually.

To which they are going to say, "well remember so and so last year .... the one the Xe got stuck a tampon in," and then I'll simply suggest we start stocking some of your recommendations in the RM's shack.

All of us older guys are on blood thinners of course .... so lately it's been a hot topic.

[GTF425]

All of us older guys are on blood thinners of course .... so lately it's been a hot topic.

In this situation, theoretically a better choice would be any of the gauze with chitosan in them. They won’t rely on your ability to form clots. Since you’ll be able to plan in advance, it’s great that you’re able to take that in to consideration and prep accordingly.

On the EMS side, I’m only able to use standard cotton gauze (Hospital based 911 service) but on the SRT I have ChitoGauze in my aid bag and it works very well.

Strike Hold

[Bruce in WV]

The stop the bleeding program stimulated our gun club to do something similar.

This IWLA club sponsors a free "Gun Club First Aid" 4-hour class a couple of times a year. We are fortunate to be in a bedroom community for D.C. commuters, and two USSS medics taught the last one. Another member, a trauma doc with ER background, will teach the next one. Focus is on "what to do until the ambulance arrives" and covers GSW, heart attacks and strokes, broken bones, and drowning (we have two fishing ponds). The board sponsors the Auto Defib and expanded first aid kit in the clubhouse, and the members are encouraged to carry a personal kit in their shooting bags. Good response from the membership for ongoing program.

[Gallo Pazzesco]

In this situation, theoretically a better choice would be any of the gauze with chitosan in them. They won’t rely on your ability to form clots. Since you’ll be able to plan in advance, it’s great that you’re able to take that in to consideration and prep accordingly.

On the EMS side, I’m only able to use standard cotton gauze (Hospital based 911 service) but on the SRT I have ChitoGauze in my aid bag and it works very well.

Strike Hold

Thank you. I just ordered $200.00 of HemCon brand chitogauze for the club. Feeling good about your advice, much appreciated.

[GTF425]

Excellent investment, and hopefully never needed.

If it hasn’t already happened, make sure to link up and participate in either a Stop The Bleed or similar course from a credible source. Technique is the most important part of all of this, and really can not be overstated.

I loved hearing that Bruce in WV received a comprehensive type of training beyond just STB. Those “basic” first aid skills (CPR, relieving choking, recognizing when to call 911, etc) go a much longer way than the needle decompression and nasal airways people have tucked in IFAKs.

[chuckman]

Excellent investment, and hopefully never needed.

If it hasn’t already happened, make sure to link up and participate in either a Stop The Bleed or similar course from a credible source. Technique is the most important part of all of this, and really can not be overstated.

I loved hearing that Bruce in WV received a comprehensive type of training beyond just STB. Those “basic” first aid skills (CPR, relieving choking, recognizing when to call 911, etc) go a much longer way than the needle decompression and nasal airways people have tucked in IFAKs.

Truth. Basics save lives. So do the others, but the basics save more lives far more often than the others. I am the life support coordinator for a major hospital (coordinate and teach all the ACLS, BLS, PALS, NRP; also teach PHTLS and TNCC), and we put heavy emphasis on 'basics'.

[teufelhund1918]

Thanks for the link. I must already be off the grid. Nothing available around my area! Although I'm not surprised.